FORM 1023-EZ for PHS PERSEVERANCE AWARD SCHOLARSHIPINC

Field Data
EIN 87-2331171
Case Number EO-2021253-000188
Form 1023-EZ version 12018
Eligibility Worksheet 1
Organization Name PHS PERSEVERANCE AWARD SCHOLARSHIPINC
Organization’s Mailing Address 425 N EL CAMINO REAL
City SAN MATEO
State CA
ZIP 94401
Accounting period End 12
Primary contact name JULIAN JACOBS
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

JULIAN JACOBS
PRESIDENT & DIRECTOR
425 N EL CAMINO REAL
SAN MATEO CA 94401

Officer/Director/Trustee Two

JEFF WOODS
TREASURER
1516 GREAT OWL PLACE
SANTA ROSA CA 95409

Officer/Director/Trustee Three

MIKE TERPKO
SECRETARY
1219 CHATEAU DR
SAN JOSE CA 95120

Officer/Director/Trustee Four

ERIC PERRY
DIRECTOR
5692 MAKATI CIRCLE UNIT A
SAN JOSE CA 95123

Officer/Director/Trustee Five

STEVE GROVE
DIRECTOR
20835 SCENIC VISTA DRIVE
SAN JOSE CA 95120

Organization’s website
Organization’s email JULIANJACOBS@GOOGLE.COM
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 8/17/2021
Organization Incorporation State CA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code B82 - Scholarships, Student Financial Aid Services, Awards
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name JULIAN JACOBS
Signature Title PRESIDENT & DIRECTOR
Signature Date 9/8/2021

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